New CPA Report: America Now Makes Just 27% of the Medicine It Consumes, Down From 72% in 2002

WASHINGTON, D.C. — The Coalition for a Prosperous America (CPA) today released a new report, “The Hollowing Out of America’s Medicine Cabinet: Two Case Studies in Lost Generic Manufacturing – and a Plan to Rebuild Domestic Capacity,” documenting the collapse of U.S. generic pharmaceutical manufacturing and laying out a policy roadmap to rebuild it. The report finds that U.S. production now supplies just 27% of domestic pharmaceutical demand, down from 72% in 2002 – the lowest share on record.

The report argues that rebuilding domestic generic drug manufacturing will require a coordinated strategy that combines tariffs with investment incentives, stronger FDA oversight, and procurement reform.

Pharmaceutical imports reached a record $292 billion in 2025, pushing the U.S. pharmaceutical trade deficit to roughly $165 billion. Since 2002, U.S. pharmaceutical consumption has grown by about $253 billion – but 99% of that growth has been met by foreign, not domestic, production. U.S. output did double over the same period, but nearly all of that increase went to exports rather than American pharmacies and hospitals.

CPA’s reporting traces the decline to subsidized foreign overcapacity in China and India, combined with a U.S. purchasing system – dominated by a handful of group purchasing organizations and buying alliances – that rewards the lowest bid regardless of the cost to supply chain resilience or drug quality. The result is visible in the data: 223 active drug shortages as of March 31, 2026, an average shortage lasting 5.3 years, and a 60% jump in drug discontinuations from 2024 to 2025. Fifty-six percent of drugs currently in shortage are priced below $1 per unit.

Two case studies clearly illustrate the stakes. Imports of liquid ibuprofen and acetaminophen – the fever medicines relied on by parents and hospitals – have doubled since early 2024, with India supplying 82.7% of import volume and China supplying 99% of ibuprofen API imports. The 2022–23 shortage forced some hospitals to crush tablets by hand and pushed the FDA to temporarily allow bulk compounding. Separately, the U.S. now imports 78% of the solid-dose tablets Americans take daily for conditions like high blood pressure, diabetes, and seizures, with India alone supplying 61% of all U.S. dispensed solid oral generic volume.

“This report shows in stark numbers what American patients and pharmacists already feel every day – our medicine cabinet has been hollowed out, and we are now dangerously dependent on a handful of foreign, sometimes even adversarial, countries for the drugs that keep people alive,” said Jon Toomey, president of the Coalition for a Prosperous America. “This didn’t happen by accident. It happened because subsidized foreign competitors flooded our market and our own purchasing system rewarded the lowest possible bid instead of reliability, quality, and resilience,” continued Toomey. “We cannot keep gambling with the health of the American people to save pennies on a pill.”

The report also documents a widening safety gap: roughly 90% of FDA foreign inspections in fiscal year 2023 were “preannounced,” compared with routine unannounced inspections at home, and some overseas plants have gone five years or more without a visit. The report cites a number of problematic situations: Ranbaxy’s $500 million fraud settlement; falsified quality records at an Intas plant supplying half of America’s cisplatin; unsanitary conditions at a Hetero Labs facility; NDMA contamination in Chinese-made valsartan; and lastly, a Glenmark potassium chloride recall linked to at least eight U.S. death reports.

“Congress and the Trump Administration have the tools to fix this – tariffs that create market space, investment incentives that make U.S. manufacturing viable again, an FDA that actually inspects foreign plants, and federal purchasing that rewards American production,” said Toomey. “It is time to use them.”